By Jean Glossa, MD, MBA, Jeffrey Ring, PhD
What do you get when you invite 15 to 20 diverse patients over to dinner to talk about their health care in their native language? Pure magic!
Take, for example, the elderly woman who stood up with tears in her eyes, brought her palms to her heart, and expressed her gratitude for the outstanding care she receives. Or consider the couple who expressed how known and loved they feel by their physician and treatment team, and how mutual that love and appreciation is toward their practitioners. One man teared up as he recounted how he struggled to get care before finding this clinic. He described illnesses and conditions of nearly every system of his body, and although he wouldn’t describe himself as completely “healed,” he was proud to report that he was able to go back to work part time.
Three focus groups held on consecutive evenings in the spring of 2017 were part of an important institutional self-reflection quality initiative undertaken by three clinics that make up Fairfax County’s Community Health Care Network. This “root-cause analysis” process was part of a larger project funded by the Robert Wood Johnson Foundation’s Finding Answers program, titled “Effects of Payment Incentives on Referral Processes in Multi-ethnic Network Serving the Uninsured”*. As part of the project, the clinics had already collected data that demonstrated opportunities to improve outcomes in the treatment of diabetes and hypertension as well as screening for cervical cancer in several ethnic groups of patients. The focus groups aimed to better understand the patient experience of care and to determine the presence of potential biases or unequal care that might account for the disparities in outcomes.
As invitations went out to patients, the planning team worried that the attendance might be low. To our great joy and surprise, the rooms filled up, night after night, and the participants came ready to speak out. After an initial welcome and explanation of the rationale for the gathering, the HMA facilitator, Dr. Jeffrey Ring, health psychologist, invited the participants to share examples of care received by them and their loved ones, both outstanding and sub-optimal. The participants soon began to speak about their health care in very personal terms. They commented on their physicians and treatment teams, on the ease (or lack) of access for appointments and phone triage, as well as medication referrals. The participants could share their stories and examples in their own language, with Dr. Ring facilitating the conversation in both English and Spanish, and with pre-arranged interpreters of other languages, so the all members of the group could fully contribute and understand the discussion.
The room felt electric. The stories were captivating. Speakers were received with knowing smiles, nodding heads, and at times, respectful counterpoints and differences of opinion and experience. Smiling elation interplayed with tearful disappointments as the stories rolled forward. As any initial shyness or hesitancy melted away, Dr. Ring found himself managing numerous—and simultaneous—excited outpourings of experience. The specifics and tangible examples patients gave will provide an impetus to rethink many aspects of how these safety-net clinics work, and to embrace strategies for transformation and improvement. Similarly, those aspects of care that are experienced as outstanding and meaningful will be targeted for preservation and enhancement.
As the evening wound down, Dr. Ring and the rest of the project team expressed appreciation to attendees for having served as the holders of wise, personal experiences of care, and the teachers and guides for improvement. The participants expressed overwhelming appreciation for the opportunity to participate, and for the experience of feeling honored, listened to, and understood. It also appeared that bonds of friendship were extended between participants through the warmth of human connection.
There is a growing movement in health care to better attend to the patient experience, in both hospitals and ambulatory care clinics. These focus groups were clearly part of that effort. The patients appeared relieved to be able to share their experiences, both positive and negative, and the experience of participation appeared to have enhanced their loyalty to the clinic and their appreciation of services offered. In other words, these gatherings proved to be feedback-rich for the clinics, and experiences of healing for the participants.
The research team will continue to pore over the findings, and to do their best to identify the often elusive causal clinical factors contributing to differences in outcomes. In the meantime, the Community Health Care Network will check the calendar, call the caterer, and look forward to providing more opportunities for patient engagement, involvement, and individual perspective in the delivery of care. It is, in fact, only by welcoming and embracing patient experience, that our health care system will rise to its full potential in quality, safety, and patient experience of care.
Dr. Jean Glossa is Managing Principal for Clinical Services and Dr. Jeffrey Ring is a Principal and Clinical Psychologist at Health Management Associates. HMA provides technical assistance to the project.